Multishot diffusion-weighted imaging features in spinal cord infarction

OBJECTIVE: The purpose of this study was to use a multishot, navigator-corrected, echo-planar (EP) pulse sequence to perform clinical diffusion-weighted imaging (DWI), analyze the DWI findings in ischemic spinal cord lesions, and discuss the value of DW magnetic resonance imaging (MRI) in distinguishing infarction (especially in the subacute stage) from inflammatory diseases and tumors of the spinal cord. METHODS: Six patients (two male, four female) with typical sudden onset of neurologic deficits caused by spinal cord ischemia were evaluated. There were no definite etiologies in these patients. Three cases occurred in the thoracolumbar region and three others occurred in the cervical cord. DWI was performed within 1-12 days after the initial neurologic symptoms by using a Philips Gyroscan 1.5 T MR system. Four patients had other scans including contrast-enhanced MRI and fluid-attenuated inversion recovery (FLAIR) scans. Two cases were followed up with MR images in 3 months. All the patients were imaged using a multishot, navigator-corrected, EP pulse sequence; apparent diffusion coefficient (ADC) values were calculated on the sagittal-oriented plane. RESULTS: MR abnormalities were demonstrated on sagittal T2-weighted images with "patch-like" or "strip-like" hyperintensities (six of six) and spinal cord enlargement (five of six). Axial T2-weighted images showed bilateral (six of six) hyperintensities. In one patient, only the posterior spinal artery territory was involved. The spinal cord was mainly affected at the cervical (three of six) and thoracolumbar (three of six) regions. Two cases involved the conus medullaris (T10-L1). The intensity of lesion signals in DW images depended on how soon after the onset of illness the scan was carried out and whether hemorrhage had occurred. In this group of patients, ADC values of lesions ranged from 0.23 x 10(-3) to 0.47 x 10(-3) mm2/s (average value 0.36 +/- 0.10 x 10(-3) mm2/s), markedly lower than the values of normal parts (average value 0.89 +/- 0.08 x 10(-3) mm2/s). There were obviously significant differences between areas with lesions and normal regions (P < 0.01). All cases had better signal contrast in DW images than in T2-weighted images. Dynamic or repeated DWI examinations may help analyze the degree of injury and recovery. Most lesions (three of four) showed nonenhanced effects in the contrast-enhanced MRI except one lesion, which showed irregular slight enhancement. FLAIR images showed poor signal contrast between lesions and normal tissue and thus are not fit for displaying infarct lesions. CONCLUSIONS: MRI is useful in detecting spinal cord infarction. DWI (especially multishot DWI) of the spinal cord may provide additional information for the assessment of ischemic changes and help improve in differentiating diagnosis.